Government perspectives on housing,technology and support design within Australia's National Disability Strategy

Australia's National Disability Insurance Scheme (NDIS) is a significant disability reform and part of a 10‐year National Disability Strategy that aims to build well‐being and inclusion of Australians with disability. Housing is recognised as a key determinant of health. Transition of state‐funded supported accommodation to an NDIS, within the new Specialist Disability Accommodation framework, aims to deliver housing responses that positively influence NDIS participant outcomes. This study aimed to gather perspectives of government disability and housing representatives on current opportunities and issues for Australians with disability. The study investigated four key research questions, relating to built design; integrated technologies; the relationship between housing and support provision; and community precinct design. Nineteen government representatives from seven of the eight Australian states and territories participated in a roundtable focus group in Melbourne, Australia (March 2017). Focus group data were audiotaped, transcribed verbatim and thematically analysed. Twelve themes were identified in response to the research questions identified. Key policy and practice implications were highlighted. This research offers insights from government that can contribute to strategic housing, technology, support and community design decisions and Australia's National Disability Strategy, to deliver improved outcomes for people with disability.     

Rural Victorian service provider responses to the National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) has transformed the nature of funding available to health and human service organisations to provide services to people with disability in Australia. However, there is relatively scant literature on the rural implementation of the NDIS, particularly how rural NDIS service providers are affected by the NDIS. Researchers conducted semi-structured interviews with 20 health professionals employed by rural providers, and analysed data using rural and remote health and organisational change frameworks to understand how rural providers were impacted by and responded to the NDIS. The findings suggest rural providers were impacted to differing extents and responded to the NDIS in different ways. Participants reported that disability and community health services were affected more than hospitals and private allied health practices. Impacted rural providers responded by changing the nature and types of services, service processes and their workforce, and redefining organisational characteristics. Impacted rural providers may require additional support to continue providing services, and those less impacted may require other incentives to better engage with the NDIS. Rural proofing of NDIS policy could reveal suitable supports and incentives to ensure rural people with disability can access required services.     

NDIS Self‐Management Approaches: Opportunities for choice and control or an Uber‐style wild west?

This article examines the emerging challenges and opportunities presented by self‐management options in Australia's National Disability Insurance Scheme (NDIS). We examine the three different ways in which NDIS participants can opt to self‐manage their funding and services, including direct employment and emerging Uber‐style online platforms, and explore the potential implications of these options for NDIS participants, service providers and the disability support workforce. In particular, we focus on these options in relation to the transition to a marketised services landscape being developed alongside the NDIS, and examine both the risks and opportunities for each stakeholder group. Through this analysis, we identify implications for policy and practice, in particular around regulatory mechanisms and the role of government within this emerging market economy and transforming service landscape.     

Australia's Individualised Disability Funding Packages: When Do They Provide Greater Choice and Opportunity?

Australia's new National Disability Insurance Scheme (NDIS) uses individualised funding packages instead of traditional block‐funded disability services to support people with disability. The NDIS works with the person and their family to assess the person's needs and develop a plan that determines their funding allocation. Funding can be used to purchase support from a disability service or from the open market. People can purchase support that suits their cultural and personal preferences. This paper examined whether individual funding packages met their aims in Western Australia, where they had been the primary mechanism of disability support for over 25 years. An exploratory case study was conducted consisting of face‐to‐face, in‐depth interviews with 11 key participants: people with disability, senior government administrators, service provider managers, and a support worker. Complex systems theory was used to review the data and findings showed that individualised funding packages did not automatically result in more choice and greater opportunities. People needed information to make informed decisions; supportive and creative support from social workers and other professionals; and welcoming communities. The findings can inform policies and assist social workers facilitate maximum choice and opportunities for people with disability and their families.     

‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.     

‘Any one of us could be among that number’: Comparing the Policy Narratives for Individualized Disability Funding in Australia and England

In this article we compare the introduction of individualized budget policies for people with disabilities in Australia and England. Data is drawn from semi‐structured interviews undertaken in Australia with politicians, policymakers, providers, disability rights groups and care planners, along with analysis of policy documents. This data is compared to the authors’ earlier research from England on the personalization narrative. We argue that the National Disability Insurance Scheme (NDIS) currently being introduced in Australia deploys an insurance storyline, emphasizing risk‐pooling and the minimizing of future liabilities. This contrasts with the dominant storyline in England in which attention has focused on the right to choice and control for a minority of the population. This difference can be explained by the different financial context: the NDIS needed to build public and political support for a large increase in funding for disability services, whereas in England the reforms have been designed as cost‐neutral. Tensions in the English narrative have been about the extent to which personalization reforms empower the individual as a consumer, with purchasing power, or as a citizen with democratic rights. Australia's approach can be characterized as a form of social investment, evoking tensions between the citizenship of people with disabilities now and the future worker‐citizen.     

Experiences of National Disability Insurance Scheme planning from the perspective of adults with intellectual disability

The Australian National Disability Insurance Scheme (NDIS) is attempting to address long‐term inequalities experienced by people with disability. Planning is central to the NDIS. People with intellectual disability will be the largest group of NDIS participants, and their perspectives are underrepresented in the literature. It is important to understand how they experience and perceive NDIS planning. Ten adults with intellectual disability participated in semi‐structured interviews to explore their experiences of NDIS planning. Data were analysed using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) six stages of thematic analysis. Six themes were identified: planning preparation not fit for purpose, creating goals, goals not met, planning not meeting real needs, lack of choice and control and importance of relationship with planner. In principle, the NDIS presents a real opportunity to increase the choice and control, social and economic participation, and independence of people with disability; however, this does not always translate into practice for people with intellectual disability.     

The Vexed Question of Market Stewardship in the Public Sector: Examining Equity and the Social Contract through the Australian National Disability Insurance Scheme

Personalized care and market‐based approaches to public service provision have gained prominence in a range of Organisation for Economic Co‐operation and Development countries. Australia has recently joined this trend, launching a complex and expansive programme of individualized care funding for disability through the National Disability Insurance Scheme. Public sector markets (i.e. where governments either directly fund a market by way of competitive tendering, or through personal budgets) have been embraced by actors at different points of the political spectrum and for a range of reasons, including efficacy and efficiency gains, empowerment of citizens and efforts to cater for diversity. Despite the growing dominance of public sector markets and individualized funding, many questions about the role and responsibility of governments in managing and regulating these markets remain unanswered. In this article we outline different roles governments might assume in the creation and management of public sector markets, based on the types of risks governments are willing to take responsibility for. We argue that to fulfil the social contract between government and citizens, governments need to ensure that markets are properly stewarded and embedded in broader social safety nets. This, we contend, can ensure citizens receive the gains of market models while being protected from market failures or market‐produced inequities.     

Mixed accountability within new public governance: The case of a personalized welfare scheme in early implementation

We explore personalized funding schemes and associated changes for accountability within new welfare governance reforms. Using the case of the Australian National Disability Insurance Scheme as hybrid institution, requiring mixed accountability arrangements, we examine the implications for broader discussions of accountability in personalized welfare arrangements. Methods used were semistructured interviews with government actors and disability service providers in Australia. In describing how accountability structures emerge, we argue that the way that layers fit together during implementation are often imperfect because of the conditions under which they arise. As a result, critical gaps can emerge in layered systems, which can put end users at risk. We demonstrate that theories on accountability in new public governance welfare reforms must also be informed by context and history informed qualitative analysis of case studies.     

Models of disability support governance: a framework for assessing and reforming social policy

In many developed countries, the provision of disability services has undergone significant transformations, from institutional to community based care, and from oganisational to personalised funding. Yet delivering disability support remains an ongoing challenge for governments. Specifically, the relative success of different types of disability support governance is convoluted and problematic given the diversity and complexity of disability support systems and the people they serve. To enhance the systematic analysis and evaluation of disability support governance, this paper conceptually advances four distinct models based on the locus of control and coordination of such support: uncoordinated; casework governance; dwelling‐based governance; and user‐coordinated. Using illustrations from case studies of individuals receiving care, the identification of these ideal types enables their relative strengths, weaknesses, and the occasions of governance failure to be articulated. No one model is universally applicable to people, nor immune to failure. Furthermore, the paper presents a novel approach to visualising actual disability support arrangements as social networks. The utility of such visualisations for analysing individual and system‐ wide arrangements is outlined. In the context of Australia's developing National Disability Insurance Scheme, these conceptual and analytical developments are argued to be important tools for policy and service analysis and reform.     

Tensions and contradictions in Australian social policy reform: compulsory Income Management and the National Disability Insurance Scheme

This paper explores contemporary contradictions and tensions in Australian social policy principles and governmental practices that are being used to drive behavioural change, such as compulsory income management. By means of compulsory income management the Australian Government determines how certain categories of income support recipients can spend their payments through the practice of quarantining a proportion of that payment. In this process some groups in the community, particularly young unemployed people and Indigenous Australians, are being portrayed as requiring a paternalistic push in order to make responsible choices. The poverty experienced by some groups of income support recipients appears to be seen as a consequence of poor spending patterns rather than economic and social inequalities. By contrast, Australia's National Disability Insurance Scheme (NDIS) has been constructed as a person centred system of support that recognises the importance of both human agency and structural investment to expand personal choices and control. Here we look at the rationale guiding these developments to explore the tensions and contradictions in social policy more broadly, identifying what would be required if governments sought to promote greater autonomy, dignity and respect for people receiving income support payments in Australia.     

Disability poverty and ageing in regional Australia: The impact of disability income reforms for indigenous Australians

Australian disability policy has undergone considerable reform since the early 2000s. While recent research and scholarship has largely focused on the new National Disability Insurance Scheme, there is a dearth of research that examines the impact of reform to the Disability Support Pension, and even less so the effects on Indigenous Australians living with disability. This is surprising as a higher proportion of Indigenous Australians live with disability than the non‐Indigenous population. This article pays particular attention to the experiences of Aboriginal Australians who have acquired a disability after extensive years of working (25–40 years), yet are still of workforce age (less than 65 years of age). Because of tightened eligibility criteria for the Disability Support Pension, people in this group are placed onto the lower paid Newstart Allowance (general unemployment benefit). The article illustrates the high levels of poverty that Aboriginal Australians with disabilities experience daily, and the ongoing costs they incur in managing Newstart conditionality to maintain continued access to the general unemployment benefit.     

Disability and migration in urban Australia: The case of Liverpool

This article presents and analyses population data on the Liverpool area of Greater Western Sydney, identifying trends with significant policy implications. Liverpool city is home to one of the highest concentrations of Australia's recent arrivals, many of whom have refugee backgrounds. From those who arrived under Australia's post-Second World War resettlement programme to new arrivals, it is also home to a rich diversity of sociocultural and linguistic communities at different stages of settlement. Demographic data show significant relationships between age, country of origin, year of arrival and need for assistance variables, many of which are either qualitatively distinct or quantitatively different from other regions in Sydney, New South Wales and Australia. Building on this analysis, the article further identifies significant policy issues in relation to disability, care and support. While Western Sydney has figured prominently in national and state public-policy directives, particularly in relation to economic growth, public infrastructure and transport mobility corridors, the analysis presented here illustrates that national policy directives for socioeconomic imperatives, such as the appropriate uptake of the National Disability Insurance Scheme, are critical to facilitate social sustainability, cohesion and equity within the region.     

Disability policy in Australia: a triumph of the scriptio inferior on impotence and neediness?

From the time that development of a National Disability Insurance Scheme arrived on the agenda of the Australian Labor Government's 2008 Ideas Summit, the lives of disabled Australian citizens have been widely discussed, consulted on, planned for and acted on. This discourse analysis (Fairclough 2003; 2010) critiques the ways in which disabled lives have been framed in these high profile policy debates, with detailed focus on two key policy documents. The Shut Out Report: the Experiences of People with Disabilities in Australia (2009) (2009) and Disability Care and Support (Productivity Commission 2011) are both grounded in extensive national consultations and provide significant evidence about the ways that disabled Australians talk about the problems they face and the solutions they advocate. The paper employs the well‐known recognition‐redistribution debate of Nancy Fraser and Axel Honneth (2003) to interpret the findings that narratives of suffering, burden and marginalisation predominate in current policy conversations. This tends to push out discussions concerning the non‐redistributive aspects of disability reform, potentially contributing to non‐integrationist discourse entrenched over 150 years of policies of segregation. Minority voices advocating social integration are present but muted. At this stage, their influence is undetermined.     

A Long‐Term Disability Care and Support Scheme for Australia: Opportunities for Disability Sector Reform

Social insurance schemes in Australasia have a long‐standing involvement in leading systemic change as well as funding services for eligible scheme participants. Establishing a long‐term disability care and support scheme for Australia provides opportunities to remove barriers to community access and improve the employment participation of all Australians with a disability, and to increase the use of evidence in policy development and in the delivery of disability supports. Using the examples of successful models in Australia and New Zealand, the authors will propose a model for the development and management of a long‐term disability care and support scheme that enables sector reform in employment participation, barriers to access and participation in all aspects of community life, and funding of disability research to benefit all Australians with a disability.     

Barriers to finding and maintaining open employment for people with intellectual disability in Australia

Everyone has the right to employment. Work is important for health, well-being, and social, economic, and financial inclusion. However, it is often difficult for people with intellectual disability to find and maintain work, especially in the open labour market. Policy challenges remain about who can access open employment (also sometimes called competitive or supported employment) and how often people with intellectual disability do so. Greater understanding about the barriers that people with intellectual disability encounter when they try to find and keep work in open employment is needed. Drawing on research with 51 people with intellectual disability in Australia, this paper examines the systemic barriers they report to finding and maintaining work in open employment. The findings highlight that the barriers they experience stem from narrow, dismissive, and discouraging attitudes to their work in open employment and from a spectrum of experiences of stigma and discrimination in open workplaces. The paper thus provides new knowledge about reasons that people with intellectual disability may either reject or not continue in open employment and take up less inclusive work options. The paper discusses the implications of the findings, including the need for policy development for attitudinal change, designing more varied roles for employees with intellectual disability, ensuring access to industrial relations protections, and increasing and better regulating and funding requirements on support to people with intellectual disability who are seeking work in open employment.     

Market stewardship of quasi‐markets by street level bureaucrats: The role of local area coordinators in the Australian personalisation system

With the rise in popularity of market‐based responses to social policy challenges, the stewardship of quasi‐markets or public service markets, is a key concern for governments worldwide. Debates about how to manage quasi‐markets have focussed on high‐level decision‐making processes. However local actors, in particular street level bureaucrats, are a key part of the complex work of managing quasi‐markets. We examine how street level bureaucrats act as local market stewards in a new quasi‐market for disability care, the Australian National Disability Insurance scheme. We find that the street level bureaucrats, known as local area coordinators, act as shapers of local markets but that their contributions are informal and often restricted by formal structures and processes. For example, we found evidence that the use of key performance indicators can disrupt effective local stewardship efforts towards a procedural approach. We conclude that introducing principles of the polycentric governance approach can improve connections between local market knowledge holders and central decision‐making agencies, thereby improving market stewardship and outcomes.     

The Consequences of Implementing a Child Care Voucher Scheme: Evidence from Australia,the Netherlands and the USA

In the Netherlands, the USA and Australia, public funding has promoted parental choice by introducing a voucher scheme for child care, where parents are free to choose the provider. The policy experiments and the outcomes in these three countries provide useful information about the consequences of introducing a voucher scheme in the child care market. We show the voucher system can be effective in increasing demand, but there can be uneven supply responses. The structure of the voucher income scheme and quality controls affect the nature of the supply response. We argue that voucher schemes must take into account the complex nature of the child care market and the substitutability among free public care, private market care and unpaid household care. To secure quality and access, government also must play a coordinating role that vouchers alone cannot supply.     

Conditionality in the context of housing-led homelessness policy: Comparing Australia’s Housing First agenda to Scotland’s “rights-based” approach

Homelessness services and policy have historically tended to be organised by an explicitly conditional logic, wherein people experiencing homelessness must prove their “housing readiness” before accessing settled housing. This model has been robustly challenged in recent decades by “housing-led” approaches that ostensibly eschew conditionality and prioritise the rapid rehousing of people experiencing homelessness. Various countries now include housing-led approaches in the national policy frameworks, including Australia, which overhauled its approach to homelessness in 2008, and Scotland, where a housing-led approach is supported by a legal right to housing for homeless households. Notwithstanding this policy shift, conditionality remains an enduring feature of responses to homelessness in both jurisdictions. This paper sheds light on this phenomenon by comparing the Australian experience with that of Scotland. We demonstrate how conditionality remains a feature of both jurisdictions; however, there is greater effort in Scotland to identify and minimise conditionality, whereas in Australia it is able to persist relatively unchallenged. We conclude with some reflections on what Australia can learn from Scotland’s relative success, highlighting the importance of a national-level policy framework and an adequate affordable housing supply.